Society Archive

Tuesday, August 11, 2009

Public About Ready for a Brave New World

Zogby International recently conducted a poll of American adults asking how likely they are to be interested in having assistive microchips implanted in their brains. Would people be interested in having the Internet wired straight to their brains, or perhaps a chip that programs the immune system to ward off all disease? Turns out that up to a quarter of the population seems willing to do it, given enough practical benefit from the implantation.

John Zogby analyzes the findings at Forbes.com:

A quick analysis reveals a hierarchy of needs. One in four would be open to allowing an artificial intelligence into his or her body to ward off disease (and possibly mortality itself). Slightly fewer are so sure knowledge is power that they too would want the chip implant. But only 6% would want a computer chip just to be entertained. Being wired to the Internet can satisfy a lot of needs, both practical and prurient. So the fact that we found 13% who might want to turn themselves into Me.com makes some sense in this needs hierarchy.
We don't know how many would-be cyberheads might actually go through with this when the hypothetical physician enters the room with surgical lasers and nano-sized computer chips in hand. But we can certainly draw conclusions from our polls about which demographic groups are most open to being hooked up to the Internet and computer technology. This is especially true in the survey of 41,175, where sub-group sizes are in the thousands.

If your first guess is that younger people are the most likely, you are correct, but only to a degree. On being wired to the Internet, the First Global generation of 18- to 29-year-olds is the leader at 24%. The percentages decline with age to only 8% of people 65 and older. First Globals are also more likely than the other age groups to want the entertainment chip, but that number is still only 10%. First Globals are about 5% more likely to want the knowledge chip. However, there is no age difference on the immunity chip question.

Read on at Forbes.com...

Image credit: Walraven

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Tuesday, July 28, 2009

POTUS Tries Out Da Vinci Surgical Robot

During Barack Obama's healthcare reform tour, while touting cheaper clinical and technological approaches for medicine, the President got a hands-on experience with the Da Vinci robotic surgical system from Intuitive Surgical. The Cleveland Clinic, perhaps having an odd sense of humor, touted to the President one of the most expensive pieces of equipment used in the OR. We are all for new technology, but opinions about costs and benefits of robotic surgical systems are far from uniform.

Here's what Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston, wrote on his blog:

Many months ago, I wrote about the da Vinci Robot Surgical System and expressed doubts about whether there was evidence to support the clinical efficacy of this equipment, as opposed to the marketing efficacy of the company selling it. Well, the time has come to graciously say, "Uncle!"
Without making any representations about the relative clinical value of this robotic system versus manual laparoscopic surgery, I am writing to let you know we have decided to buy one for our hospital. Why? Well, in simple terms, because virtually all the academic medical centers and many community hospitals in the Boston area have bought one. Patients who are otherwise loyal to our hospital and our doctors are transferring their surgical treatments to other places. Prospective residents who are trying to decide where to have their surgical training look upon our lack of the robot as a deficit in our education program. Prospective physician recruits feel likewise. And, these factors are now spreading beyond urology into the field of gynecological surgery. So as a matter of good business planning, concern for the quality of our training program, and to continue to attract and retain the best possible doctors, the decision was made for us.

So there you have it. As the company's latest device, the da Vinci Si HD Surgical System, comes with a $1.75 million price tag, it is not clear whether the healthcare reform plan would consider alternative, more traditional laparoscopic devices, as a saving option to the modern, advanced technology found in the Da Vinci.

Link: White House Blog......

Medgadget archives: da Vinci Surgical System...

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Thursday, July 2, 2009

Where Are Medicare Stories at BarackObama.com?

We rarely delve into politics. But if we must, Independence Day is probably a good occasion.

So over coffee and a brioche, we were reading Health Care Stories for America @ BarackObama.com. There we noticed an interesting pattern: scolding of health insurance companies is on at full steam, but no one wants to talk about the elephant in the room: Medicare. And that's where the real health care dollars are being sucked in, like into a giant black hole.

Don't believe our independent Medgadget team of doctors? Ask practically any other physician, and he or she will tell you about real horrors. How about stories where hundreds of thousands of dollars are spend on each patient that has practically hit the wall? How about pacemakers and AICDs on 90 year olds with Alzheimer's, Parkinson's or stroke? How about interventional radiology procedures, where a terminal elderly patient becomes a cushion pad for physicians? How about CAT scans, MRIs, leg bypasses, peripheral catheters, exploratory laparotomies, and hundreds of lab tests that are done every day, that often prolong more suffering than life?

We understand that there are many problems in healthcare when it comes to younger patients. We know that people lose jobs, have prior conditions, and as a result they end up losing their insurance coverage. We also understand there are abuses in the health insurance industry. But the real bulk of the societal problems is not with the people under 60, but with older patients. In other words, with Medicare. And when families, who don't have to co-pay for any medical services, are being asked to estimate the risk/benefits ratios of going ahead with a treatment, the hope itself forces them to go "all in." And that is how the tax payer's money are being spent nowadays. For all the talk over at the Health Care Stories for America, there is indeed little substance but lots of fear. And that is from the administration that has promised us hope.

And, finally, the real question. Why does the President and his team use the wrong symbol of Caduceus for his health care initiative? As we noted before, the Staff of Asclepius should be a single serpent encircling a staff, and no wings and no snake families, please. We hope you have a nice Independence Day!

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Thursday, April 30, 2009

Google Flu Trends, Mexico Edition

Google, in a speedy effort to point their query crystal ball toward swine flu, just launched Google Flu trends for Mexico. The site, just like Flu Trends for the US, looks at aggregate user search queries that might indicate a higher prevalence of flu in a region. Though they don’t publish the specific methods involved, if, say, millions of users in a region started searching for something like “achy muscles and fever” or “I think I’ve got the flu,” the software might notice the trend and note it on the website. Though it’s certainly not perfect, the primary benefit to this approach is that it has the potential to pick up on flu outbreaks a bit quicker than other epidemiological data because it’s real time and avoids the lag of a patient getting to a hospital, then the data getting to an agency like the CDC, etc. Google is calling the site “experimental” for now because they’ve not yet had the chance to validate their models against good clinical data, but decided that they wanted to get it launched as quickly as possible.

Let’s just hope that the swine flu is not transmissible to computers; even my ThinkPad was in a panic today.

From the Official Google Blog:

In response to recent inquiries from public health officials, we've been attempting to use Google search activity in Mexico to help track human swine flu levels. Experimental Flu Trends for Mexico is, as you might have guessed, very experimental. But the system has detected increases in flu-related searches in Mexico City (Distrito Federal) and a few other Mexican states in recent days, beginning early in the week of April 19-25.
In the United States, we were able to validate our estimates using data from a surveillance system managed by the U.S. Centers for Disease Control and Prevention (CDC). We have not verified our data for Mexico in the same manner, but we've seen that Google users in Mexico (and around the world) also search for many flu-related topics when they have flu-like symptoms. Given the tremendous recent attention to swine flu, our model tries to filter out search queries that are more likely associated with topical searches rather than searches by those who may be experiencing symptoms.

While we would prefer to validate this data and improve its accuracy, we decided to release an early version today so that it might help public health officials and concerned individuals get an up-to-date picture of the ongoing swine flu outbreak. As with our existing Flu Trends system, estimates are provided across many of Mexico's states and updated every day. Our current estimates of flu activity in the U.S. are still generally low as would be expected given the relatively low confirmed swine flu case count. However, we'll be keeping an eye on the data to look for any spike in activity.

Google Blog: Experimental Flu Trends for Mexico

Flashback: Google Joins Nanny State to Monitor Flu?

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Wednesday, April 1, 2009

PDA and Smartphone Usability in Clinical Practice

The Healthcare Human Factors Group, a research organisation affiliated with Canada's University Health Network, has conducted a usability study assessing the intuitiveness of five different PDA's and smartphones during four basic scenarios that nurses typically experience. This is all very interesting as the number of portable clinical applications we feature on these pages has been growing rapidly.

Here is a snippet from the summary findings:

Important Considerations

Nurses expect lightweight devices with physical keyboards, advanced rendering capabilities, intuitive menu structure and data access speeds that are comparable to desktop applications

Devices need to be portable and compact; ideally weigh less than 180g

Larger screen sizes are preferred, so long as page rendering is advanced

System speed perception was also an important indicator of device acceptance; in addition, Wi-Fi compatible devices are recommended

Be mindful of the types of applications and tasks the nurses will be using most; if text entry is required for the majority of tasks, a device with a physical keyboard is recommended

From an infection prevention and control standpoint, devices that can easily be used with a protective cover that can be easily wiped with a disinfectant are recommended. Those devices with the fewest buttons, connectors, and crevices that could trap microbes are considered best. From the devices that we reviewed, the iPhone 3G and iPAQ 210 would be most suitable in this regard.
Recommendations

The Blackberry Bold and iPhone 3G were found to be acceptable devices. The Nokia N810 also met or exceeded the performance of these devices, but was generally considered too bulky and heavy for nurses to use on a routine basis. The Palm Treo 680 and HP iPAQ 210 are not recommended.

Read on for the details: Human Factors Evaluation of PDAs and Smartphones in Nursing Practice...

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Friday, February 6, 2009

A Long, Difficult Future Foreseen for Personalized Genetic Medicine

Scientists at the University of Pittsburgh are throwing a serious dose of skepticism into the personalized medicine industry. While using genetic tests to determine one's susceptibility to a disease and/or treatment sounds like a great idea, in practice we're a long ways away from effectively implementing the technology.

From a statement by the University to Pittsburgh:

The study focused on single nucleotide polymorphisms, or SNPs -- variations in short DNA sequences that have been linked to the presence of particular diseases, and that exist in the millions in the human genome. A number of companies currently offer individualized estimates for disease risks based on genome-wide SNP genotyping. These tests typically scan 500,000 to 1 million SNPs, searching for only a handful associated with a specific disease.
Dr. Weeks and colleagues focused their study on diseases for which there are strongly associated genetic variants: age-related macular degeneration, type 2 diabetes, prostate cancer, cardiovascular disease and Crohn's disease. They found that a strong genetic association did not guarantee they could accurately discriminate between actual disease cases and controls in both mathematical models and real-world examples.

Part of the problem may be a statistical one. To provide meaningful insights, a test for disease risk needs to accurately identify positive cases and, at the same time, provide a low false positive rate. One of the challenges with current approaches to genetic testing is that they are based on a very small number of common variants, "making it likely that you will identify people at high risk who may not be at risk at all," said Dr. Weeks. "With such a small pool of variants, it's difficult to develop a very meaningful test for predicting disease risk."

In addition, he said, few health care providers have adequate genetics training to make sense of the risk calculations now commercially offered and to advise their patients accordingly.

Press release: Are we selling personalized medicine before its time?

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Tuesday, January 6, 2009

Military Aims to Design Virtual Moms and Dads

The Pentagon is initiating a project to build a virtual parent, a software application that would be used by children with military parents out on deployment that don't have the time to communicate with their kids. As the Department of Defense is building simulated moms and dads, the Orwellian aroma is unmistakable. But fear not, this project is currently only at the stage of seeking proposals from companies interested in tackling the idea in practice.

From the DOD project overview:

The challenge is to design an application that would allow a child to receive comfort from being able to have simple, virtual conversations with a parent who is not available "in-person". We are looking for innovative applications that explore and harness the power of advanced interactive multimedia computer technologies to produce compelling interactive dialogue between a Service member and their families via a pc- or web-based application using video footage or high-resolution 3-D rendering. The child should be able to have a simulated conversation with a parent about generic, everyday topics. For instance, a child may get a response from saying "I love you", or "I miss you", or "Good night mommy/daddy." This is a technologically challenging application because it relies on the ability to have convincing voice-recognition, artificial intelligence, and the ability to easily and inexpensively develop a customized application tailored to a specific parent. We are seeking development of a tool which can be used to help families (especially, children) cope with deployments by providing a means to have simple verbal interactions with loved ones for re-assurance, support, affection, and generic discussion when phone and internet conversations are not possible. The application should incorporate an AI that allows for flexibility in language comprehension to give the illusion of a natural (but simple) interaction. The current solicitation is not aiming to build entertainment, but a highly accurate and advanced simulation platform. Voice-recognition and voice-interaction are required. The User Interface is a critical component for this program. Application must be user friendly and application must be easy to install and maintain. Verbal interactions should be as normal as current technology will allow. Proven track record for creating similar types of applications is desired, but not required. Development plans should include the use of trained psychological health and family advocacy experts with experience providing services to military populations. Project MUST include discussion of how personal information would be collected, recorded, and rendered as well as address issues about information content and complexity of proposed simulation application. If using a web-based application, security and maintenance issues must be addressed. Application must run on typical family-owned computer systems.

DOD request from proposals: Virtual Dialogue Application for Families of Deployed Service Members

Image: deryckh

(hat tip: InformationWeek)

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Monday, January 5, 2009

Advancing Systems Biology for Medical Applications

The European Science Foundation has just released a science policy briefing titled Advancing Systems Biology for Medical Applications, a document that provides an excellent overview of systems biology and its possibilities for medicine and science. The policy briefing also looks at the Pan European strategy to harness the awesome might of this emerging science.

The document is embedded bellow (you can zoom in or print it), but if you want to download the policy briefing, head over here.

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Friday, December 12, 2008

DNA Lab On A Chip is Coming Tomorrow

We are in a feisty mood today. The Engineer Online is reporting on an EU funded SMART-BIOMEMS project that aims to develop a microchip that can do DNA analysis for clinical applications such as detecting signs of cancer in blood. This is one of the examples of pan-European cooperation that we constantly see over the wires, that never seem to make it past EU's bureaucratic directives (in this case, "IST Programme of the EU's Sixth Framework Programme (FP6) under contract number IST-016554"). It seems to us that an average 10 person startup from Silicon Valley tends to deliver results better than multinational projects run by Brussels.

Anyway, here's what The Engineer Online proclaims about the project:

Project coordinator Gianluca Vezzani said: ‘What we are developing here is a comparatively inexpensive, easy-to-use and portable point-of-care system that will have very real clinical benefits.
‘As there are biochemical reactions occurring on the device, it has to be set up with specific reagents and biological protocols appropriate to the task at hand, and we chose cancer for the initial testing because it is such an important field.’

For the final testing of the system, the human gene TP53 will be tested in the system to identify possible cancerous mutations. The sample will be inserted into the device and the power will then be switched on to move the fluid sample within the microfluidic chip by the pressure control unit.

The results of the test will be compared to a conventional DNA procedure to check its accuracy rate. These results will be analysed by specialised software and transmitted to a standard PC.

Tuesday, November 11, 2008

Google Joins Nanny State to Monitor Flu?

Drudge is reporting that Google plans on releasing a tool to the federal government that uses data gathered from web searches for flu related keywords to notify health agencies where an outbreak might be happening. Lets for a minute ignore the privacy implications of this project and think of the potential benefits of an early warning system that notices patterns as soon as people start getting the sniffles.

Google explains its methodology:

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for "flu" is actually sick, but a pattern emerges when all the flu-related search queries from each state and region are added together. We compared our query counts with data from a surveillance system managed by the U.S. Centers for Disease Control and Prevention (CDC) and discovered that some search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in various regions of the United States.

During the 2007-2008 flu season, an early version of Google Flu Trends was used to share results each week with the Epidemiology and Prevention Branch of the Influenza Division at CDC. Across each of the nine surveillance regions of the United States, we were able to accurately estimate current flu levels one to two weeks faster than published CDC reports.

CDC uses a variety of methods to track influenza across the United States each year. One method relies on a network of more than 1500 doctors who see 16 million patients each year. The doctors keep track of the percentage of their patients who have an influenza-like illness, also known as an "ILI percentage". CDC and state health departments collect and aggregate this data each week, providing a good indicator of overall flu activity across the United States.

So why bother with estimates from aggregated search queries? It turns out that traditional flu surveillance systems take 1-2 weeks to collect and release surveillance data, but Google search queries can be automatically counted very quickly. By making our flu estimates available each day, Google Flu Trends may provide an early-warning system for outbreaks of influenza.

Developing at Drudge...

Project page: Google Flu Trends...

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Thursday, October 30, 2008

TIME Magazine Panders to Google Overlords, Silicon Valley Czars, Hollywood Charlatans

This is just a hoot! TIME magazine has released its guide to 50 Best Inventions of 2008, and the numero uno on the list, The Retail DNA Test, is not even an invention. Based on old technology, called SNP genotyping, retail DNA testing (also known as direct-to-consumer (DTC) genetic testing) is a growing industry with services that many consider to be of questionable value. Don't take our word for it: we are just doctors who blog in pajamas. Take note instead from the Genetics and Public Policy Center at Johns Hopkins University, which has just received a two-year NIH grant to study the industry:

Right now, [Gail Javitt, a principal investigator at the Genetics and Public Policy Center] explains, we know very little about the DTC landscape or how it will affect health and health care in the future. Genetic tests for more than 1,300 diseases or conditions are available clinically, and the number is growing rapidly. Theoretically, almost any genetic test for these diseases could be offered directly to consumers, and more than 30 companies already have entered the DTC genetic testing market, including major players Navigenics, 23andme, and deCODE...
“There is a lot of hype and a lot of angst about how personal genome testing will play out in health care,” Javitt noted. “What’s missing are hard facts about this industry and its consumers, and what the public’s motivations for, and experiences with, these tests have been.”

And if you read TIME magazine's stupendous award announcement, you will notice that the editors are not even sure themselves:

California and New York tried to block the tests on the grounds that they were not properly licensed, but have so far been unsuccessful. Others worry about how sharing one's genetic data might affect close relatives who would prefer not to let a family history of schizophrenia or Lou Gehrig's disease become public. And what if a potential mate demands to see your genome before getting serious? Such hypotheticals are endless. And some researchers argue that the tests are flawed. "The uncertainty is too great," says Dr. Muin Khoury, director of the National Office of Public Health Genomics at the Centers for Disease Control and Prevention, who argues that it is wrong to charge people for access to such preliminary and incomplete data. Many diseases stem from several different genes and are triggered by environmental factors. Since less than a tenth of our 20,000 genes have been correlated with any condition, it's impossible to nail down exactly what component is genetic. "A little knowledge is a dangerous thing," says Dr. Alan Guttmacher of the National Institutes of Health.

So what to make of the award announcement? We say, TIME was probably sucking up to people whose lives have become a never ending effort to hype things onto the common man. You see, whether you take 23andme's Anne Wojcicki and her husband Sergei Brin (co-founder of a website Google.com, an advertising agency with no customer service), or 23andme's investor movie mogul Harvey Weinstein, or Navigenic's venture capitalist John Doerr, they feel that they are changing the world. But really, considering the hype, aren't they more interested in making money and elevating themselves to the level of revolutionaries, than furthering medicine and its technology? Doing a genetic test is not like listening to an iPod, or watching Pulp Fiction. Has Weinstein ever heard of false positive medical results? How about that every test always has such results? And what about cost-benefit analysis, so important in medicine? Do you really believe that Wojcicki can explain why we do mammograms every year, but not chest X-rays? After all both can detect cancer...

We say these VIPs have all the right to run their enterprises, but to say that what they offer is an important service and revolutionary service would be far off the mark. TIME can do it, but our modest team of medical tech enthusiasts just can't.

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Wednesday, August 27, 2008

Heart Wars: Anti Hacker Cloaking Device Proposed for Pacemakers

Researchers at the University of Washington, Seattle propose a method to build cloaking devices that can effectively shield implantable pacemakers and similar devices from interference by hackers, a problem whose potential reality has been shown to exist in the laboratory.

Article abstract:

A fundamental tension exists between safety in the common case and security under adversarial conditions for wireless implantable medical devices. We propose a class of new, fail-open defensive techniques for implantable medical devices that attempt to strike a balance between these two goals. We refer to these defensive techniques as Communication Cloakers. Cloakers are externally worn devices, much like computational Medical Alert bracelets. Cloakers protect the security of an IMD when worn, but allow for open access during emergencies if removed.

Article: Absence Makes the Heart Grow Fonder: New Directions for Implantable Medical Device Security (PDF)

(hat tip: Engadget)

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Monday, July 21, 2008

Introducing Medpolitics.com: A Voice for Doctors

We are very proud to unveil a new web service called Medpolitics.com, a blogging site open to US physicians to opine on healthcare, public health, politics of medicine, and the state of our profession. The time seems perfect considering that healthcare is such a hot debate topic, and many doctors feel that we should have a stronger voice in the debate. We figured we know a thing or two about blogging and healthcare. So why not build a service where doctors write their political thoughts and others read them and comment? We hope that one day politicians, policy makers, news makers, and others will be checking it out to see what the doctors actually think on the important medical policy issues.

So we registered the domain, installed a user-friendly publishing software, and gave it some testing. The site is now ready to go, all without any significant investments (except for our time) or outside funding. In other words, 100% independent political network for doctors.

Some features of the website: WYSIWYG (What You See Is What You Get) blog editor, drag and drop picture uploading, social networking (make friends, establish contacts), bookmarking, event announcements, polls creation, and much more. The publishing on Medpolitics is as easy as writing an email: no knowledge of HTML is necessary. Again, the site is open for blogging to US physicians only, and everyone else can follow the debate and comment. We have a person on staff to treat everyone who signs up the old fashioned way, "like a doctor." That means continuous support, a phone number to call for help or to explain how to do something, and the utmost attention to all your requests. What blogging platform will do that for you?

We are not looking for thousands of members, but just for some of you that care for the future of our profession and have the desire to have your opinions heard. So let's see if the experiment will work, and whether we can get some of the quiet voices out. Sign up now, and if you have that Blogger account that gets drowned in a sea of chatter, move it and join other physicians. A few voices together are definitely louder than individuals scattered all over.

If you have any questions, please get in touch with us via this contact form.

See you in the debate halls of Medpolitics.com!

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Monday, July 14, 2008

Medgadget Interviews Dr. J. James Rohack, President-elect of the AMA

Medgadget rarely ventures into politics. However, after one of our editors contacted the American Medical Association (AMA) public relations department to check out how the AMA is doing, we were offered a chance to talk to senior leadership in the organization. We, of course, couldn't have missed such an opportunity! The result is an interview with J. James Rohack, MD, a cardiologist from Bryan, Texas, in the Texas A&M Health Science Center College of Medicine, and recently announced president-elect of the American Medical Association. Dr. Rohack will assume the AMA presidency in about a year from now, in June 2009.

We'd like to note and to give credit to the AMA for not officiating this discussion, for not setting limits or requesting in advance the questions we were planning to ask.

Medgadget: Dr. Rohack, my name is Michael Ostrovsky. Welcome to Medgadget, I think everything is working very well now.

Dr. Rohack: Great, very good.

Medgadget: We really appreciate you giving us this opportunity to interview the president-elect of American Medical Association. It's a great opportunity for us. Just to let you know about Medgadget. We are a physician edited blog, and we've been discussing the AMA a little bit among ourselves, and would like to ask a couple questions about the AMA and its future. First question would be.. Can you give us a little summary of the mission of the AMA at the present time, in these turbulent for physicians political times.

Dr. Rohack: From a historical perspective, as well as right now, our mission is to promote the art and science of medicine, and the betterment of public health. Our three major areas of focus, however, that we are trying to accomplish is to make sure that the 47 million Americans that are uninsured do now have health insurance. And it is through a process of changing the Federal tax code so that those that can't afford health insurance can get tax credits to purchase their own health insurance. The second is to fundamentally reform the Medicare system. Medicare was created 40+ years ago, [it] is still siloed as far is its payments, it is still backwards as far as how the system works, in that it took almost 37 years to finally get a drug benefit, and we still see that Congress, having to go to Congress to say "We need to cover immunizations" is kinda backwards. And the third thing we're focusing on is improving the quality and safety, and that's through not only continuation of our involvement in standard setting for medical education, both at the medical school, the graduate medical education, and continuing education, but more importantly taking a look at tools that we can help physicians in their offices how care is being provided in different ways, to reduce the duplication that maybe out there that maybe unnecessary, that physicians may not have the tools to help them. So, clearly there are many other areas we're involved with, but those are the top three.

Medgadget: Also, I'm sure you know that there is a lot of disagreement among doctors, some would even say discontent among doctors, with the AMA, with the organization itself. Do you feel this is a time when the AMA is having more difficulty reaching physicians with its message. Specifically, are you seeing any evidence of this discontent among physicians in your membership numbers?

Dr. Rohack: Well, certainly our historical process that we've had for getting feedback from physicians has been tied to our house of delegates that assembles twice a year with physicians representing every state and specialty. However, it's also a recognition that the technology has changed. We've also looked at weblogs and other venues where physicians are being engaged for us to get an experience if that's something we should be more involved with, to interact with our members. A few years ago we started to do what's called 'Member Connect surveys', where we sent electronically to our membership individual questions, that they could respond to, to help shape our annual agenda that we put together. So I think that one of the things that the American Medical Association has done over the last decade is recognize that the historical past of how communication occurred with doctors... that is doctors coming to the AMA twice a year, the doctors then returning back to their community, and then those doctors being responsible for communication, has left the average AMA member, in fact has left the average doctor, completely unaware of what the AMA is doing. The other recognition that we have, our house of delegates which meets twice a year, is a very open, deliberative, democratic body. We don't bar the press from those deliberations. And it is so democratic, that any individual can bring a resolution to that debate, so that any time the resolution that is introduced happens to be on social policy, where the country hasn't come up with a consensus, unfortunately sometimes the press, that becomes the headlines, and it really distorts all the things the AMA does to help the actual practice and doctor in their every day life.

Friday, June 27, 2008

Some Worrying News for Clinical RFID Industry

A Dutch study published in the June 25 issue of JAMA assessed the effects of electromagnetic interference (EMI) from RFID (radio frequency identification) devices on hospital equipment. The authors report that they have discovered that critical care gadgets can undergo major malfunctions thanks to EMI.

Here's the nugget from the American Medical Association press release:

Remko van der Togt, M.Sc., of Vrije University, Amsterdam, the Netherlands, and colleagues conducted a study in a controlled, non-clinical setting to assess and classify incidents of electromagnetic interference by RFID on critical care equipment. The tests were performed in a one-bed patient room in an intensive care unit (ICU) and with no patients present. Electromagnetic interference by two RFID systems (active [with batteries and ability to transmit information] and passive [without batteries, information retrieved by RFID reader] was assessed in the proximity of 41 medical devices (in 17 categories, 22 different manufacturers). The devices included items such as external pacemakers, mechanical ventilators, infusion/syringe pumps, dialysis devices, defibrillators, monitors and anesthesia devices. Incidents of EMI were classified according to a critical care adverse events scale as hazardous, significant, or light.

All 41 medical devices were submitted to 3 EMI tests resulting in 123 EMI tests. A total of 34 EMI incidents were found; 22 were classified as hazardous, 2 as significant, and 10 as light. The passive signal induced a higher number of incidents (26 in 41 EMI tests; 63 percent), and hazardous incidents (17), compared with the active signal.

Hazardous incidents included: total switch-off and change in set ventilation rate of mechanical ventilators; complete stoppage of syringe pumps; malfunction of external pacemakers; complete stoppage of renal replacement devices, and interference in the atrial and ventricular electrogram curve read by the pacemaker programmer.

The median (midpoint) distance between reader and device at which all types of incidents occurred was 11.8 inches. Hazardous incidents occurred at a median distance of 9.8 inches.

Press release: ELECTROMAGNETIC INTERFERENCE FROM SOME RADIO FREQUENCY IDENTIFICATION DEVICES MAY POSE HAZARDS TO MEDICAL EQUIPMENT ...

Abstract: Electromagnetic Interference From Radio Frequency Identification Inducing Potentially Hazardous Incidents in Critical Care Medical Equipment JAMA. 2008;299(24):2884-2890.

Image credit: lyzadanger @ Flickr: Tags Before Surgery

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Tuesday, June 24, 2008

FDA Claims Faster Device Approvals

The FDA's Office of Device Evaluation has released a report of its activities for fiscal years 2006 and 2007. Among other things, the FDA is claiming that its approval process has been expedited, allowing for faster answers to device approval applications.

Pharmalot reports:

In a new report, the agency maintains it is now faster at approving applications than in 2002. In fiscal 2006 the FDA, on average, took 335 days to approve the devices, which range from X-ray machines to syringes, compared with 438 days in 2005, Reuters writes.
But approval of devices under a separate, abbreviated “510K” application process required, on average, 95 days in 2006, compared with 87 days in 2005. Nonetheless, the FDA argues “the average review time from receipt to final decision has declined” since Congress passed a law overhauling device regulations in 2002. Approval data for fiscal 2007, which ended last Sept. 30, was not yet available.

Wednesday, May 28, 2008

Health MSM Under Indictment

An independent team of analysts reviewed 500 health stories published in American main stream news media, and the results may hint to why so many consumers are confused, and are willing to trust at-home homeopath as much as they do their local medical reporter.

A summary of the results from the PLoS Medicine article:

The daily delivery of news stories about new treatments, tests, products, and procedures may have a profound—and perhaps harmful—impact on health care consumers.

A US Web site project, HealthNewsReview.org (http://HealthNewsReview.org/), modeled after similar efforts in Australia and Canada, evaluates and grades health news coverage, notifying journalists of their grades.

After almost two years and 500 stories, the project has found that journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.

Reporters and writers have been receptive to the feedback; editors and managers must be reached if change is to occur.

Time (to research stories), space (in publications and broadcasts), and training of journalists can provide solutions to many of the journalistic shortcomings identified by the project.

To note, Medgadget was not one of the sources reviewed by the study.

Full article in PLoS Medicine: How Do US Journalists Cover Treatments, Tests, Products, and Procedures? An Evaluation of 500 Stories

(hat tip: WSJ Health Blog)

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Thursday, April 17, 2008

Warnings for Online Health Record Systems

The New York Times points us to an article, published in the New England Journal of Medicine, that raises some warnings about taking personal health records online, and entrusting them to third parties not bound by HIPAA regulations:

...Microsoft and Google, the authors note, are not bound by the privacy restrictions of the Health Insurance Portability and Accountability Act, or Hipaa, the main law that regulates personal data handling and patient privacy. Hipaa, enacted in 1996, did not anticipate Web-based health records systems like the ones Microsoft and Google now offer.
The authors say that consumer control of personal data under the new, unregulated Web systems could open the door to all kinds of marketing and false advertising from parties eager for valuable patient information.

Despite their warnings, Dr. Mandl and Dr. Kohane are enthusiastic about the potential benefits of Web-based personal health records, including a patient population of better-informed, more personally responsible health consumers.

“In very short order, a few large companies could hold larger patient databases than any clinical research center anywhere,” Dr. Mandl said in an interview.

But the authors see a need for safeguards, suggesting a mixture of federal regulation — perhaps extending Hipaa to online patient record hosts — contract relationships, certification standards and consumer education programs.

Tuesday, April 8, 2008

The Cult of The Amateur

Medgadget, though a blog, has always had the policy of providing professionally edited information to our readers. In important matters such as medicine, we believe expertise is absolutely essential, and we are often shocked by websites that attempt to revert long established practices that, more often than not, are not subject to debate among physicians and industry researchers. Yet claims to the safety of contact with mercury abound, the dangers of vaccinations are over-hyped, and pregnant women are regularly promoted the idea of choosing to give "natural" birth with a midwife in the comfort of their home. The result? Babies born at home tend to have more problems afterward, and contagious preventable diseases are on the rise.

Much of this "information" stems from the nature of the Internet itself. When one's expertise in a subject often counts for naught, people, who for whatever personal reason tend to provide their uneducated version of truth to an unsuspecting public, become experts.

Dutch filmmaker IJsbrand van Veelen has been extremely critical of this trend and the dangers that it implies, and has produced a film with a particular focus on Wikipedia and the nature of its content:

More at TechCrunch...

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